While early recognition of upper quadrant lymphedema secondary to cancer can play a crucial role in maintaining quality of life for patients, few clinical practice guidelines (CPGs) exist to help clinicians diagnose the condition. The APTA Oncology Section set out to change that with the publication of “Diagnosis of Upper Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of the American Physical Therapy Association” in Physical Therapy (PTJ), APTA's science journal. An executive summary of the CPG will be published in Rehabilitation Oncology’s July issue.
Authors Kimberly Levenhagen, PT, DPT; Claire Davies, PT, PhD; Marisa Perdomo, PT, DPT; Kathryn Ryans, PT, DPT; and Laura Gilchrist, PT, PhD, evaluated research on current diagnostic and assessment methods, including bioimpedence analysis, circumferential measurement, water displacement, perometry, and ultrasound imaging.
In a podcast summarizing the work group’s recommendations, coauthor Claire Davies reminds clinicians, “We need to be aware that none of the diagnostic criteria are perfect in their diagnostic accuracy, especially [in] patients that fall just under or over a cut point. These [patients] have the potential to be misclassified. Also, the clinical presentation of lymphedema should influence the selection of diagnostic tool, as some measures … are more accurate in the early stage.”
Physical therapists need to tailor the diagnostic approach to each patient. For example, Davies told PT in Motion News, “in some groups with early or subclinical lymphedema, volume measures may not be sensitive enough to diagnose and/or assess extracellular fluid. As tissue changes occur with later stage lymphedema, volume may be increased, yet measures of extracellular tissue fluid may not be as accurate due to fibrotic changes.”
Authors of the CPG “encourage clinicians to cluster findings from their examination,” using the most appropriate tests recommended for each of the clinical presentations, to draw a conclusion on diagnosis.
In her podcast, Davies ends “with a call for research.” Among their recommendations, authors of the CPG urge “further psychometric testing of the tools currently being used to assess and diagnose [secondary upper quadrant lymphedema].” They point out the need for research that examines diagnostic criteria at different stages of this condition. Further research should examine what “combination of history, symptoms, and other measurements” is “most accurate” for diagnosis, they state.
Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA.